Association between the RTS,S/AS01 malaria vaccine and under-nutrition in children aged 10 to 59 months in Siaya County, Kenya

Background: Under-nutrition is a global problem associated with infectious diseases including malaria. In this study, we explored the association between the newly introduced malaria vaccine, RTS,S/AS01 and measles vaccine with under-nutrition in children. Methods: We conducted a case-control study using anthropometric data for children aged between 10 and 59 months in Siaya County, Kenya collected from September to December 2021. Malaria and measles vaccines were the exposure variables, and under-nutrition, which is a composite variable including stunting and/or underweight was the outcome. Chi-square was used to test association between under-nutrition and the two vaccines. Further, a binary logistic regression was used to assess association between the vaccines, and independent variables with a confidence interval set at 95%. Results: From a total of 1,701 children, 185 (16.8%) were undernourished. Among the undernourished children, 121 (11.0%) were stunted and 64 (5.81%) were underweight. The undernourished children were matched with children of normal nutritional status at a ratio of 1:1 giving a total of 370. Malaria vaccine coverage was low at 21.1% (39/370) and 17.3% (32/370) among undernourished and children with normal nutritional status respectively. Similarly, the measles vaccine coverage was 30.8% (57/370) and 36.2% (67/370) among cases and controls respectively. Neither exposure to malaria nor measles vaccines showed a statistically significant difference between the cases and controls. Conclusions: We found no statistically significant association between malaria vaccine and under-nutrition in children. While malaria vaccine is important in protecting children from the malaria disease effects, it is not a proxy intervention for under-nutrition.

Prevalence and Antibiotic Resistance Patterns of Escherichia coli among Hospitalised Patients at Thika District Hospital

Background: Emerging resistance to antimicrobial drugs increases morbidity and mortality by hampering the provision of effective chemotherapy; and makes treatment more costly. The emergence of resistance to antimicrobial agents is a global public health problem; especially in pathogens causing nosocomial infections. Objectives: To determine the carriage of E. coli from wounds and urine in catheterised inpatients at Thika District Hospital (TDH) and to determine antimicrobial resistance patterns to Beta-lactams; aminoglycosides and (fluoro) quinolones. Design: A cross-sectional study. Setting: Thika District Hospital among hospitalised patients. Subjects: A total of 450 specimens were collected and forty two (42) Escherichia coli isolated. Pus swabs were collected from wounds and urine was collected aseptically from the inpatients with catheters. Escherichia coli were identified by culture methods and biochemical tests. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method and interpreted according to Clinical Laboratory Standards Institute recommendations. Results: Susceptibility results in aminoglycosides were; resistance for amikacin; gentamicin and kanamycin was 20; 39 and 51 respectively. Resistance in penicillin was ampicillin 85 and piperacillin 83 . Resistance for sulfamethoxazole was 83; tetracycline 66 ; nalidixic acid 44; nalidixic acid 44 and chloramphenicol 39and chloramphenicol 39. In amoxicillin/clavulanic acid; resistance was 68 . Cephalosporins' resistance was ceftazidime 22 ; cefotaxime 56 . Resistance for imipenem and tazobactam was 7 and 12 respectively. Conclusion: Due to observations on resistance to antimicrobial agents commonly used in Thika District Hospital; this shows that there is need to revise antimicrobial policy in this region in the treatment of E. coli infections

Typhoid Fever in Sub-Saharan Africa: Challenges of Diagnosis and Management of Infections

Typhoid fever; caused by Salmonella enterica serovar Typhi (S. Typhi); is a disease transmitted by the faecal-oral route. It continues to be a public health problem in many developing countries in sub-Saharan Africa. School-age children; especially those from resource-poor settings with inadequate water and sanitation systems; are dispropor- tionately affected. It is estimated that a total of 400;000 cases occur annually in Africa; an incidence of 50 per 100;000 persons per year. Lack of effective diagnosis often leads to inappropriate treatment and management of these infections. Additionally; the emergence and spread of S. Typhi strains having multiple resistance to nearly all commonly available drugs in most developing countries has been a major challenge to health care systems; reducing the effective treatment options for the disease; increasing treatment costs and increasing the risk of complications and death. Although not much data from sub-Saharan Africa has been published; it seems clear that typhoid is common in Nigeria; Mali; Ethiopia and Kenya. Given the importance of information on disease incidence for targeting control measures; including improved sanitation and water supply; vaccination and assessing impact; priority should be given to strengthening surveillance systems for typhoid fever

Tetracycline resistance genes in salmonella tyhimurium in a hospital in Kenya

Tetracyclines have been among the most widely used antibiotics worldwide. Plasmid-mediated tetracycline resistance among hospital strains of bacteria has increased through the many years of usage. The major concern has been the transfer of resistance to pathogenic organisms. Bacteraemia due to S. typhimurium has been a major cause of morbidity at Kenyatta National Hospital (KNH); hence the need to study drug resistance patten of this organism and to characterize the tetracycline resistance genes using oligonucleotide probes. 97 S. typhimurium strains isolated from patients at KNH were used. Agar dilution method was used todetermine minimum inhibitory concentration (MIC). Plasmids were isolated from each strain and the different plasmid profiles were grouped by their molecular weights into 6 plasmid profile groups. Tetracycline resistance genes were characterized using oligonucleotide probes. 87 out of 97 (88) strains were resistant. MIC ranged from 1 ug/ml to 128 ug/ml. Genes encoding for tetracycline resistance were located on plasmids of molecular weights 65 MDa; 5.2 or both. Salmonellosis is a public health problem in Kenya especially bacteraemia due to S. typhimurium. Plasmid-encoded natimicrobial resistance is likely to spread to other pathogenic organisms; reduce our ability to treat the infection and increase cost and duration of treatment